NPIMap

Organization Active NPI

Klarisana Physician Services PLLC

  • General Practice Physician
  • Longmont, CO
National Provider Identifier
1306503446
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
KLARISANA PHYSICIAN SERVICES PLLC
Practice address
916 S Main St Unit 208
Longmont, CO 80501-6617
Phone
(210) 556-1430
Fax
(888) 504-2390
NPI assigned
Nov 23, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Alyssa Soto
Title
Administrative Director
Phone
(210) 556-1430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

916 S Main St Unit 208
Longmont, CO 80501-6617

Mailing address

8600 Wurzbach Rd Ste 1110
San Antonio, TX 78240-4334
Phone (210) 556-1430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221213000493 CO Part B Supplier - Clinic/Group Practice 1759659238 Receives reassigned benefits from 22 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Centennial, CO; Denver, CO; Longmont, CO; Thornton, CO

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Klarisana Physician Services PLLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637625600000",
    "number": "1306503446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 WURZBACH RD STE 1110",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782404334",
            "telephone_number": "210-556-1430",
            "fax_number": "888-504-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 S MAIN ST UNIT 208",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016617",
            "telephone_number": "210-556-1430",
            "fax_number": "888-504-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KLARISANA PHYSICIAN SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-23",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A",
        "authorized_official_last_name": "SOTO",
        "authorized_official_first_name": "ALYSSA",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "210-556-1430",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.